Loneliness and alcoholism

Loneliness questionnaires were distributed to 152 subjects--92 males and 60 females undergoing treatment in selected alcohol rehabilitation centers in a large midwestern state. The extent of loneliness was investigated in relation to 10 selected variables. It was found that younger persons were significantly lonelier than older persons and that women were significantly lonelier than men. The researchers also found that there was a relationship between loneliness and self-rated state of health and ease in making friends. The following variables--education, socioeconomic status, adequacy of income, religiosity, number of close friends, and frequency of going out forsocialreasons, did not significantly affect loneliness scores for the alcoholic subjects.

Loneliness is a human condition that afflicts all people at some point in their life cycle. It has been called the most devastating malady of the age (Tournier, 1961). Allan Fromme (1965) said, "Like the common cold, loneliness is easy to catch, hard to cure, rarely fatal but always unpleasant and sometimes wretched almost beyond bearing" (p. 158).

Woodward (1988b) remarked, "Loneliness is a fact of life; we all must contend with it. Loneliness is always present to a degree; there is no complete escape" (p. 1). He further explained that loneliness is a part of living, of being human, of loving and being loved, of caring and being cared for. It can be a devastating experience-or a creative one.

Rubin (1979) commented that even those individuals who had good interpersonal relationships, devoted and loving families, satisfying careers, and busy social lives experience loneliness at one time or another.

Vaux (1988) found that both social and emotional loneliness were inversely associated with provisions of social relationships, with appraisals of support, and with both quantitative features (size, frequency) and qualitative features (closeness, reciprocity, complexity) of social support networks.

Social and emotional loneliness also were associated inversely with personal characteristics, particularly discomfort in social situations, self esteem, and negative orientation toward support networks.

As a group, alcoholic individuals appear to exhibit many of the personal, social, emotional, and relationship problems that also are associated with loneliness. The use and abuse of alcohol has become one of the major threats to our nation's health, ranking closely with cancer and heart disease (Nelson, 1985). Eighteen million adults in the United States are problem drinkers. More than 10 million of these drinkers suffer from alcoholism [National Institute on Alcohol Abuse and Alcoholism (NIAAA), 1981]. Alcohol abuse is a major contributing factor for fatalities from automobile accidents, drowning, suicides, fires, and falls and has been implicated in domestic violence (NIAAA, 1981). Alcoholism in the United States cuts across all educational, occupational and socioeconomic boundaries (Coleman,1988).

Millions of American marriages and families are adversely affected by the drinking of one or both of the partners (Burns 1989), resulting in more than 25 million children of alcoholics (NIAAA,1981). Alcoholism, therefore, has been referred to as a "family disease" (Krimmel, 1973). Alcoholic individuals may lose jobs, behave abusively, disappear periodically or have extramarital relationships (Steinglass,1987). Bengelsdorf (1970) commented that the abuse of alcohol, ``has killed more people, sent more victims to hospitals, generated more police arrests, broken up more marriages and homes, and cost the industry more money than has the abuse of heroin, amphetamines, barbiturates and marijuana combined (p. 7)."

George Gallup (1982) remarked that alcoholism was becoming a widespread problem because of the weakening of family ties, high mobility, and lack of communication between parents and children. Verdery (1973) remarked that alcohol may be used to reduce anxiety, help deny reality, assist one in maintaining social superiority and poise, boost one's ego and self-confidence, and ward off unacceptable thoughts and irrational fears.

There is limited research on the phenomenon of loneliness and alcoholism. The researchers found only four studies which directly focused attention on the relationship between loneliness and alcoholism.

Sadava and Thompson (1986) explored drinking behavior and alcohol problems in relation to loneliness. They found that loneliness was significantly related to alcohol problems, but not to alcohol consumption. They concluded that loneliness appears to be a source of vulnerability to alcohol problems.

Singer, Blane and Kasschair (1964) compared a group of alcoholics with a group of nonalcoholics on three aspects of social isolation: current close social contacts, stability in maintaining social involvements, and positive ties with the community. The researchers found that the group of alcoholics were significantly more socially isolated on the three specified measures of social isolation when compared to the nonalcoholic group.

Calicchia and Barresi (1975) surveyed a group of 140 alcoholic subjects and a control group of nonalcoholics and studied the relationship between alcoholism and alienation. Dean's Social Alienation Scale was administered to the subjects in both groups of 10 to 12 individuals. The results suggested that the alcoholic subjects were significantly more alienated than the nonalcoholic subjects. The subjects in the alcoholic group also experienced greater social isolation, powerlessness, and normlessness. Sex differences were observed for the alcoholic sample. In the alcoholic group, the males were significantly more socially alienated than the females.

Allen, Peterson, and Whipple (1981) tested three groups of alcoholic individuals at different stages in the recovery process for loneliness. The first group was comprised of 15 alcoholics who were going through detoxification--these were the acute alcoholics. The second group consisted of alcoholics in the outpatient treatment who had encountered at least two episodes of drinking in the last six months--these were the chronic alcoholics. Finally, the third group consisted of alcoholics who had at least one year of sobriety--these were the recovering alcoholics. The three groups were matched for marital status, educational background, and work history. The Sisenwein Loneliness Scale was used to assess the extent of loneliness. The researchers found that the acute alcoholic group was significantly more lonely when compared to the recovering group. There were no significant differences, however, between the acute and chronic alcoholic groups, or between the chronic and recovering alcoholic groups. An interesting finding that emerged was that the mean loneliness score for the recovering group was significantly lower than the combined mean loneliness scores of the acute and chronic alcoholic groups.

This descriptive study examines the extent of loneliness among individuals who were undergoing treatment at selected alcoholic rehabilitation centers. The extent of loneliness was investigated in relationship to gender, religiosity, age, education, adequacy of income, social class, number of close friends, self-rated health, ease in making friends, and frequency of participating in social activities. The study was limited to alcoholics who were undergoing treatment in alcoholic rehabilitation centers in a mid western state.

The following hypothesis was developed and tested: There is a significant influence on loneliness scores of the alcoholic sample for the following demographic variables: gender, religiosity, age, levels of education, feelings of adequacy of income, socioeconomic status, number of close friends, self-rated state of health, ease in making friends, and frequency of going out for social reasons.

METHOD
The sample consisted of 152 alcoholic subjects: 92 males and 60 females who were undergoing treatment in seven alcohol rehabilitation centers in a midwestern state. The age range of subjects was between 19 years and 55 years. Of the 152 subjects, 40% were in the 19 to 25 years range, followed by 30% who were in the 26 to 35 years range. Nineteen percent of the subjects were in the 36 to 45 years range and 11% were in the 46 to 55 years range. A large majority (76%t) of the persons who participated in the present study were White. Fifteen percent were American Indians and 6% were Asians. There were only three Hispanic subjects and two Blacks.

A 75-item questionnaire constructed by Woodward (1967) was used to collect the data. This instrument was comprised of two parts. Part I consisted of biographic social, and demographic information. Part II was comprised of the Loneliness Inventory. This Inventory was made up of 75 questions which asked the subjects to indicate whether they were (a) almost always lonely; (b) often lonely; (c) sometimes lonely; (d) rarely lonely; or (e) never lonely, under various conditions and circumstances. I n addition to the above five classifications, there was a sixth category, (f) does not apply, for items which did not pertain to a particular subject. The scores were weighted and averaged.

The Loneliness Inventory has a reliability of .96 (Cronbach Alpha) and a test re-test reliability of .97. Criterion validity was established by correlating the scores on the Woodward Loneliness Inventory I with a six-level selfrating measure of loneliness. Subjects rated themselves as

I am the most lonely person I know.
I am more lonely than most people.
I am as lonely as most people.
I am less lonely than most people.
I rarely feel lonely.
I never feel lonely.
The resulting correlation of .93 was found to be significant beyond the .001 level. A correlation of .87 (p < .001) was also obtained (Woodward,1988b) with the revised UCLA Loneliness Scale (Russell, Peplau, & Cutrona, 1980).

Researchers gave the questionnaires to an alcohol counselor at participating rehabilitation centers who in turn distributed the questionnaire to the alcoholic patients. Counselors explained the nature of the study and gave specific instructions regarding how the questionnaires needed to be filled out. Instructions also specified that responses would be kept strictly confidential and that no names or identification of any kind were needed on the questionnaires.

RESULTS
Analysis of variance one-way classification was used to test the difference in loneliness scores between males and females, religious and non-religious individuals, and among age groups, levels of education, adequacy of income, socioeconomic groups, and number of close friends. The results of this analysis are found in Table 1.

The Pearson product-moment correlational analysis was used to test the relationship between loneliness scores and the variables of self-rated health, ease in making friends, and frequency of going out for social reasons. The results are shown in Table 2.

DISCUSSION
A statistically significant difference in the loneliness scores of men and women was found. Women were significantly more lonely when compared to the men. The findings of this study are in agreement with those of Woodward (1971), Seevers (1972), Otto (1972), Gladbach (1976), Medora, Woodward, and Larson (1988), and Woodward and Frank (1988a). The present findings, however, are not in agreement with those of Calicchia and Barresi (1975), who found alcoholic males to be significantly more lonely when compared to alcoholic females.

Loneliness scores were not found to be associated with religiosity. One would generally assume that respondents who indicated that they never went to church would be most lonely. In this study, however, this was not found to be true. Subjects who stated that they went to church about once a month had the highest loneliness scores, while those who never went to church or those who went to church once a year, had the second highest loneliness scores. Subjects attending church every two weeks were least lonely, followed by those who responded that they went to church more than once a week or once a week.

The results of the analyses for age groups indicated a statistically significant difference between the loneliness scores of younger alcoholic subjects and older alcoholic subjects. The younger alcoholic subjects were significantly more lonely when compared to the older alcoholic subjects. One of the possible reasons for this trend could be attributed to the notion that with increasing age, people learn to accept and cope with loneliness as an inevitable part of life. Whereas, subjects in the younger age group may have very high and unrealistic expectations about life and as a result are unable to cope with the feelings of loneliness when they are plagued by them.

No statistically significant differences were found among the mean loneliness scores of subjects with varying educational backgrounds. Data suggested that individuals who had "special job training" had the highest mean loneliness scores, while subjects who indicated that they had "completed graduate degrees" had the lowest mean loneliness scores. Respondents who chose the other options fell somewhere in between. There was no statistically significant trend regarding loneliness scores and educational background. It was concluded, therefore, that level of education was not related to loneliness.

There was no significant difference in the loneliness scores among individuals in the various categories concerned with feelings of adequacy of income. Data suggested that respondents who stated that they could afford everything they wanted and still have extra money had the highest loneliness scores. Conversely, those who mentioned that the present money situation was not at all adequate, followed close behind. Subjects who stated that they could afford everything they wanted had the lowest loneliness scores (1.65) and were thus least lonely. These subjects are probably satisfied and contented with life they way it is.

There was no statistically significant difference in the loneliness scores among subjects in the various socioeconomic classifications. The loneliness scores suggested that respondents who fell in the "skilled workers or foremen" category had the lowest loneliness scores. While the subjects who indicated that they were "professionals" had the highest loneliness scores. A probable reason why professionals had higher loneliness scores could be attributed to the fact that persons who were professionals set out to achieve high standards and goals for themselves, but perhaps, because of alcoholism were unable to achieve these high standards. This sense of failure might be causing these individuals to experience feelings of loneliness. It can, therefore, be said that socioeconomic status did not significantly affect alcoholic subjects' Loneliness scores.

There was no significant difference in the loneliness scores among individuals and the number of close friends they had. Thus, the popular notion that the more friends a person has the less lonely they are likely to be, did not hold true for this research study. Number of close friends was not found to be associated with loneliness. These findings are in agreement with those of Visser (1971), Seevers (1972), and Medora (1986).

The subjects were asked to rate their health on a scale from excellent to very poor. A significant negative relationship between loneliness and self rated state of health was found. The results suggested that the healthier the individuals the less lonely they were likely to be and vice versa. These findings seem logical and in the expected direction. It is a well-documented fact that ill health creates several psychological and emotional Prepercussions and loneliness may be just one of them.

There was a significant relationship between loneliness scores and ease in making friends. Individuals who stated that they "almost always" and "often" found it easy to make friends had lower loneliness scores when compared to persons in the other three classifications--"sometimes""rarely," and "never", found it easy to make friends. Even though the number of close friends was not found to be positively associated with loneliness, ease in making friends seemed to be an important variable that significantly influenced the extent of loneliness for the alcoholic subjects. These findings confirm the earlier findings of Seevers (1972) and Medora (1986).

The correlation coefficient between loneliness scores and frequency of going out for social reasons was not significant. The loneliness scores for this variable were not widely dispersed. Instead, the scores were clustered together and ranged from 1.86 to 1.93. It was concluded that frequency of going out for social reasons was not related to loneliness scores.

Coping with Loneliness
Loneliness should not be seen as an admission of personal failure. People should be told that they need not necessarily be brave or desperate to say that they are lonely. Woodward (1988b) emphasized that there is no cure for loneliness. There are, however, ways to put it off, to ease the pain, and to suffer it less frequently. He provided eight practical suggestions to cope with loneliness:

(1). First, lonely people have to recognize and admit that they are lonely. Before an alcoholic can benefit from treatment, he or she must acknowledge that they have a problem with alcohol. Very few people are willing to admit that they are lonely, but that is the essential first step.

(2). Next, Woodward (1988b) emphasized that to relieve feeling of loneliness you have to reach out to others. You must be willing to take risks. If you are rejected, reach out again, and again until you find someone who would like a relationship with you.

(3). Be honest with others. When you meet someone and are asked, "Hi, how's it going today?" Don't reply, "Fine!" if it's not. If you are feeling lonely simply say, "I wish I had somebody to talk to." They may not want to hear about all of your problems, but maybe they need someone to talk with, too. If you expect people to share their lives with you, it is necessary to share your life with them.

(4). When you go out socially, don't expect too much. Go out just to have fun. Many lonely people go out with a different motive. They expect to find the perfect person, a lifelong friend, or a future spouse. Since the chances of satisfying these high expectations at any given time is very low, these individuals become discouraged. They may give up and decide to stay at home, watch television, drink, or engage in some other solitary activity. You can enjoy relationships that are less than perfect, they don't necessarily need to be deep and lasting.

(5). The family is the most important institution for dealing with loneliness. It is the one group that can't make you an "ex." You may have an ex-husband, ex-wife, ex-girlfriend, ax-boyfriend, or ex-boss, but you will never have an ex-family. Regardless of family problem, you still belong to your family. If something is wrong within the family, try to straighten it out. Possibly you are part of the problem and therefore can become part of the solution.

(6). Individuals who have an outside interest that excites them and that they work at vigorously have fewer problems with loneliness. Outside interests need to be different from work activities. They provide an opportunity to meet people from different walks of life.

(7). Joining organizations is another way to relieve feelings of loneliness. Joining is not enough, however. You must become involved, take responsibility, and participate in the activities to relieve your loneliness. (8). Friends are important. Everyone needs a group of friends who may not always agree with them, but who always accepts them. (Medora & Woodward, 1986; Seevers, 1972; Visser, 1971) found that it is not the number of close friends that is important, but the ability to make friends that make the difference. The quality or degree of closeness is the key to relieving feelings of loneliness.

Woodward (1988b) concluded that any or all of these suggestions will help you fight loneliness, but only you can cure your loneliness.

Practical Significance of the Study
The findings of the present study could give alcohol rehabilitation authorities and family life educators valuable information regarding loneliness and addiction to alcohol. Since the current findings indicate that alcohol subjects tend to have high loneliness scores, counselors, therapists, and educators could incorporate discussions on loneliness in group activities, workshops, and debates. The counselors could advise subjects that all persons will encounter loneliness; that it is normal and inevitable. They could further discuss issues on accepting loneliness and provide clients with alternative ways on how they can cope with and overcome feelings of loneliness.

There was a significant negative relationship found between loneliness scores and state of health. Alcoholic subjects who were in poor health had significantly higher loneliness scores when compared to those alcoholics in good health. Health promotion professionals should use this information when they treat alcoholic patients. Educators could incorporate the realities of alcohol use and discuss responsible drinking when they address groups on the issues related to loneliness and alcoholism. Nelson (1985) emphasized that drunkenness should be considered a drug over dose and never be condoned.

SUMMARY
The present study was a descriptive study designed to investigate the extent of loneliness experienced by alcoholic individuals in relation to 10 selected variables. The study assessed the degree of loneliness of alcoholic patients in relation to age, gender, education, socioeconomic status, adequacy of income, religiosity, self-rated health, number of close friends, ease in making friends, and frequency of participating in social activities. Questionnaires were distributed to 152 alcoholic subjects: 92 males and 60 females who were between the ages of 19 and 55 years.

The results of this study indicated that statistically significant differences were found to exist among individuals in the various age ranges and between males and females. In addition, there was a significant relationship between loneliness scores and self-rated health and ease in making friends.

No statistically significant differences were found for the following variables: education, socioeconomic status, adequacy of income, religiosity, number of close friends, and frequency of going out for social reasons.

TABLE 1

ANALYSIS OF VARIANCE, F VALUES, AND DEGREES OF FREEDOM FOR
DIFFERENCES IN LONELINESS SCORES AND SELECTED VARIABLES OF
ALCOHOLIC SUBJECT

COMMENTARIES
The editorial staff of Wellness Perspectives: Research, Theory and Practice encourages professionals to comment on contemporary issues and concerns. We are committed to presenting all appropriate opinions and viewpoints on such issues.

In a recent issue of Wellness Perspectives: Research, Theory and Practice (Volume 6, No. 1, 1989 pp. 46-55) Drs. Gold, Gilbert, and Greenberg provided commentary on the need to slow down and rethink the process being used to credential health educators. These authors do not negate the need for credentialling of health educators, but express concern in regard to the process used by the National Commission for Health Education Credentialling, Inc.

In this issue, a rebuttal is offered by Dr. Thomas O'Rourke. His thoughts have been structured to carefully respond to the concerns raised by Robert Gold, Glen Gilbert, and Jerrold Greenberg. Wellness Perspectives: Research, Theory and Practice welcomes your commentary on the credentialling of health educators or any other issue germane to the profession.

~~~~~~~~

By Nilufer P. Medora California State University at Long Beach and John C. Woodward University of Nebraska-Lincoln

Nilufer P. Medora is an associate professor in the Department of Home Economics at California State University at Long Beach. John C. Woodward is a professor of Human Development and the Family, University of Nebraska-Lincoln.